a disruptive innovation in general practice · 2013-06-21 · presentation by harry longman and...
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A Disruptive Innovation in General Practice
Harnessing Innovation King’s Fund 19 June 2013
Harry Longman, Dr Steven Laitner [email protected]
[email protected] 07939 148618
Tighter funding
Growing list and rising workload
Longer waits, patients complaining
STRESS
A&E demand rising nationally
Source: HES, CHKS
4
One thing I have always found is that you have got to start with the customer
experience and work backwards to the technology.
Steve Jobs 1955-2011
The receptionist asks “How can I help you?”
The doctor calls you back, surprisingly fast.
Phone Completed…some examples from yesterday
• Treatment and investigation left at reception for lady with cystitis calling from Boots
• Advice and reassurance to 93 year old who has just returned from holiday in Spain
• Cradle cap treatment and information
• Recurrent Shingles treatment
When would you like to come in and who would you like to see?
To come in …examples from yesterday
• 77 year old lady with new neck and arm pain, seen 30 minutes after calling
• Lady with suspected urine infection called at 8.45am, leaving surgery seen, investigated and treated and on way to work at 10.15am
• 68 year old with possible chest infection requesting home visit, seen at preferred time at surgery
• Double appointments for two patients with multiple complaints
How? A new system. Simple, but different
PA Navigator measures the flows, which vary by GP & practice.
Reception takes call
GP phones patient
Problem solved
Come and see GP Admin question
Come and see nurse
20%
20% 10%
30%
60%
60%
Patient demand is predictable, by day and by hour
All data from Clarendon, charts by PA Navigator
Innovation: a significant positive change. Addressing the problem “I can’t get to see my GP.”
Launch 25/7/11 Within 2 weeks, mostly
same day
Wait is rising
Data from Thurmaston HC, charts by PA Navigator
Clarendon, Salford: wait to see a GP falls off a cliff.
All data from Clarendon, charts by PA Navigator
The Elms, Liverpool. Spot the intervention.
All data from The Elms, charts by PA Navigator
Clarendon: more patient contacts, but less time. Now reducing a session. Others saving more.
All data from Clarendon, charts by PA Navigator
Meaning the GPs can be ready. Median response 30 mins.
All data from Clarendon, charts by PA Navigator
90% of patients choose to be seen same day. Fine.
All data from Clarendon, charts by PA Navigator
Patients are more likely to see the same doctor. Continuity, so precious to both, is up 15%
This means that on multiple consultations, a patient has about 85%
chance of same GP
All data from Clarendon, charts by PA Navigator
Research shows patients 20% less likely to attend A&E
At mean deprivation, line
shows 21% saving
Best fit line for 31 Patient
Access practices
Best fit line for 8,000
practices
Design H Longman, A&E data calc EMQO from HESOnline FY0910, deprivation from SPH
Example, Thurmaston after first full year…
A&E visits down 49% ACS admissions down 64%
Emergency admits down 14% Elective admits down 49%
May be from a high base but isn’t all this worth a look?
Practice Profile Information November 2012 C82678 Thurmaston Medical Centre, South Charnwood QIPP Indicators Area 3
Indicator Aspects
Identified
Indicator Specifics
Date of
Information
Data Source (where it comes
from)
Information
Format
Previous Data Position Latest Data Position - 2012/2013 Additional
Explanation Practice Practice CCG Average Target
Area 3.1 Q&P Indicators
New Outpatient Attendances (GP ref., exc. Obs., MH & Midwife Episodes)
April - Sept 2012
HERA
%
March 2011
2.7 See glossary.
Target definition has changed
-17.3
-0.3
On Target 0.0 or
below (e.g. -0.2)
Within Target
Emergency spells by practice 0-3 days
%
23.7
20.3
9.7
Over Target
A&E Attendance Activity per 1000 of weighted population (all providers)
%
256.69
129.63
94.31
n/a
Above CCG Average
Area 3.2 Emergency Admissions
Ambulatory Care Sensitive Conditions Admissions Activity (all providers)
April - Sept 2012
HERA
% of List Size
March 2011
1.77
0.63
0.58
n/a
Above CCG Average
Frequent Flyers
%
Not Collected Last Year
0.67
0.55
n/a
Above CCG Average
Area 3.3 Planned Care
Elective Admissions (all providers)
April - Sept
2012
HERA
% of List Size
March 2011
13.83
6.99
6.06
n/a
Above CCG Average
Area 3.4 HERA Access
Frequency HERA Accessed (reports included specified in Glossary)
Sept - October
2012
HERA
Number of
Hits on HERA
Not Collected Last Year
6
30.52
Access Once a
Week
Below CCG Average
Area 3.5 Medicines Management
Prescribing Budget overall spend against allocated budget
April - August
2012
Medicines Management
%
March 2012
11.70
3.24
-1.74
In Budget 0.0 or below
(e.g -1.7)
Over Budget
Area 3.6 QIPP Sign Up
Areas of QIPP Practices have NOT agreed to take part in
July 2012
CCG returned Sign Ups
n/a
n/a
“How are we going to help all our patients, all day, every day?”
Consensus
Preparation
Staff survey Patient survey Data capture Training System setup Whole team
New deal for patients Feedback wall Test & learn Build confidence
Launch day
Routine
Review Evidence: New measures New staff survey
Yes. Pledge to each other and to patients
The launch programme changes everything in 12 weeks…
We are helping CCGs and practices to change
• 80+ diverse practices • 600,000 patients • 250 years experience • 7 million patient calls • Growing research • Vision: “To transform
access to medical care.”
www.patient-access.org.uk
Patients’ view of the new system is clearly influenced by the experience of response time, as perceived by them
Patients polled shortly after receiving a call from a GP. 15 practices, n=1328 responses
Patients saying it is better have waited
average 43 mins
Patients saying it is worse waited an average 60 mins
Being called by my own or usual GP also makes an important difference to patients’ approval of the new system
Patients polled shortly after receiving a call from a GP. 15 practices, n=1328 responses total, 441 excluded, no preference for usual GP
67% of patients saying it is better
were called by their usual GP
47% of patients saying it is worse
called by usual GP